Professional Documents
Culture Documents
Group 10
Station 4
7-3PM
Capitol University
Medical City
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
It can cause:
coughing that produces large amounts
of mucus (a slimy substance)
wheezing
shortness of breath
chest tightness
and other symptoms
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Cigarette smoking
is the leading
cause of COPD as
evidenced by the
smoking history or
exposure of the
COPD patients.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Types of smoker
•Current smoker - has smoked 100 cigarettes in a lifetime
and now smokes every day or some days.
•Former smoker - he has smoked 100 cigarettes in a
lifetime and does not smoke at all.
•Never smoker - has not smoked a cigarette and has never
smoked 100 cigarettes in a lifetime.
•Light smoker - smokes 5 or fewer cigarettes per day
occasionally.
•Moderate smoker - smokes 6 to 21 cigarettes a day.
•Heavy smoker - smokes more than 21 cigarettes a day.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
•7 out of 10 Filipinos
smokes
• 5.5 million of them have
the disease
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
COPD
• 8th leading cause of death in the country
next to heart disease, vascular system
diseases, cancer, accidents, and some other
illnesses.
Philippines
• 2nd country in Asia who has the highest
number of COPD cases next to Indonesia.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Patient’s Profile
Age: 71 years old
Sex: Male
Status: Married
Address: Balingasag, Misamis Oriental
Citizenship: Filipino
Religion: Roman Catholic
Occupation: Retired
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Family history
•Diabetes mellitus type 2
•Hypertension
•Asthma
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Self-Perception/ Self-Concept
Pattern
“Kung unsa man ang naa sa ako,
mag.enjoy ko…kung nay kwarta,
mag.enjoy ra gihapon. Kay mao
ramay kalipay” as verbalized.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Role/Relationship Pattern
• married
• retired
• has four children- all working
professionals and are in good physical
condition
• live with his family in Balingasag
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
• Roman Catholic
• Always goes to church and chats with his
church mates a lot
• God is vital to everyone and he trusts in God
on whichever turn his condition will be.
• He says that hospitalization truly interferes
as he can’t go to church because of his
illness.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Review of Systems
General oriented to time, place, and person; a bit
restless
Integumentary no rashes noted
EENT no epistaxis
Musculo-skeletal no joint pain
Respiratory no hemoptysis
Cardiovascular chest pain noted
Gastrointestinal no diarrhea
Genito-urinary no dysuria
Nervous no seizure
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Review of Systems
Skin no rashes
Head-EENT dusky pulpebral conjunctiva,no
lymphadenopathy
Lymph nodes no cervical lymphadenopathy
Lungs Symmetrical chest expansion, (+) crackles at
the left anterior and
right posterior lung base, (+) wheezing sound
noted
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Review of Systems
Cardiovascular enlarged shape, no murmur
Crackles upon
Crackles upon auscultation
Post Operative Scar
auscultation
(heart bypass surgery) in
2005
Removed
prostate
Laboratory
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Hemoglobin (Hgb)
This test measures the grams of
hemoglobin found in a deciliter of
whole blood. It correlates closely
with the RBC count and affects the
Hgb-RBC ratio.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Hematocrit (Hct)
It measures the percentage by volume of
packed RBC in a whole blood.
Purpose: To assess the extent of a
patient’s blood loss.
Lab Result : Hct
Indication/s: Low Hct suggests
hemodilution.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Segmenters (Segs)
Lymphocyte
Lab Result: Lymphocyte
Indication/s: Caused by
corticosteroid therapy
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Monocyte
Lab Result: Monocyte
Indication/s: Caused by
corticosteroid therapy
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Eosinophil
Lab Result: Eosinophil
Indication/s: May be
increased by allergic
reactions, and skin infection.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
CLINICAL CHEMISTRY
Creatinine
is a nonprotein end product of
creatinine metabolism. Serum creatinine
test provides a more sensitive measure
of renal damage than blood urea
nitrogen levels because renal
impairment is virtually the only cause for
creatinine elevation.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Potassium (K+)
is the major intracellular cation. It is
important in maintaining cellular
electrical neutrality. Evaluation of
serum potassium measures the
extracellular levels of this
electrolyte.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Nursing Implication/s:
Observe patient for decreased
reflexes, mental confusion,
hypotension, muscle
weakness.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
URINALYSIS (11/18/10)
Test Result
Color Yellow
Transp Turbid
Reaction 6.0
Sp gravity 1.015
Sugar Negative
Protein +3
Coarse granular cast 1-2 cells/ hpf
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Protein
The urinalysis is a routine
screening test which is usually done
as a part of a physical examination,
during preoperative testing and
upon hospital admission.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
Bacteria
Bacteria may also be noted via the
microscopic examination of the urine. Should
bacteria be found during a routine urinalysis,
culture and sensitivity testing of the urine
should be done to determine the organism
and to provide assistance in determining
appropriate antimicrobial therapy.
Chronic obstructive
pulmonary disease
Introduction Client’s Profile Pathophysiology NCP
auscultation
Productive cough:
retained Decrease 3.
R: To provide maximum lung expansion.
Increased fluid intake into 2-3L per day
expectoration of
mucus secretion.
yellowish color mucus respiratory rate unless contraindicated. However, rales
Dyspnea from 32 to 27 cpm R: Hydration helps decrease viscosity off were still noted
Use of trapezius secretion Show 02 saturation secretions facilitating expectoration. upon
muscle when increased from 93% 4. Encouraged pursed- lip breathing auscultation.
breathing to 95% exercises. Respiratory rate
Nasal flaring R: Provide client with some means to was only
Restlessness cope dyspnea and reduced air trapping. decreased to 27
RR- 32cpm 5. Performed chest tapping after cpm.
O2- 93% administration of nebulization. 02 Saturation
Orthopnea R: To aid in expectoration of phlegm. was increased to
DEPENDENT: 96%.
1) Administer oxygen therapy via nasal
canula of 2 LPM.
R: To correct hypoxemia
2) Administer Combivent 1 nebule every 8
hours as ordered.
R: Helps to dilate and smoothen bronchioles.
3) Administer Fluimucil 600mg 1tab in 1/3
glass of water O.D as ordered.
R: To liquefy secretions.
4) Administered Senetide 250mg discuss
inhaler BID 8am, 6pm.
R: Helps dilate and smoothen bronchial area.
ASSESSMENT DATA NURSING GOALS AND OBJECTIVES NURSING INTERVENTIONS AND RATIONALE EVALUATION
(Subjective & Objectives DIAGNOSIS
Cues) (Problem and
etiology)
Subjective Cues:
“Diri ra ko gapangihi sa
Activity At the end of 1-2 days of
nursing intervention, the
Independent:
1) Re-evaluated client’s response to activity.
Goals partially met.
Patient
bedside kay dali ra kayo ko intolerance patient will be able to: Note reports of dyspnea, increased showed and
kapuyon kung mu.adto pa ko related to Demonstrate weakness/fatigue, and changes in vital signs demonstrated
ug CR” as verbalized by the improved activity during and after activities. an improved
patient. exhaustion tolerance without R: Establishes client’s capabilities/needs and activity
Objective Cues: dyspnea and fatigue facilitates choice of interventions. tolerance such
Tachypnea upon associated Long term goal: 2) Assisted in passive range of motion exercises. as ambulation
exertion with Participate in R: Promotes blood circulation. around the
RR: 32 cpm
imbalance activities of daily 3) Provided a quiet environment and limit room and
Dyspnea living more visitors during acute phase as indicated. sitting upright
Easy fatigability between importantly in toilet Encourage use of stress management and but dyspnea
O2 Saturation: 93% transfer and diversional activities as appropriate. was still noted
oxygen ambulation. R: Reduce stress and excess stimulation, upon exertion.
supply and promoting rest. Long term goal:
4) Assisted client to assume comfortable However, we
demand position for rest/sleep. were not able
R: Client may be comfortable with head of bed to evaluate
elevated, sleeping in chair, or leaning forward on whether the
overbed table with pillow support. goal of
5) Provided a quiet environment and limit participating
visitors during acute phase as indicated. in activities of
R: Reduces stress and excess stimulation, daily living
promoting rest. were met.
Dependent:
6) Administered oxygen therapy via nasal
canula of 2 LPM.
R: To correct hypoxemia
7) Administered Combivent 1 nebule, OD as
prescribed by physician.
R: To aid in normalization of respiratory pattern
8) Administered Senetide 250 mg discuss
inhaler BID as prescribed by physician
R: To aid in normalization of respiratory pattern
ASSESSMENT DATA (Subjective NURSING GOALS AND OBJECTIVES NURSING INTERVENTIONS AND EVALUATION
& Objectives Cues) DIAGNOSIS RATIONALE
(Problem and
etiology)
Subjective Cues: After 3-4 hours of nursing Independent: Goals partially met.
“Sa isa ka adlaw, daghan kayo Imbalanced intervention, patient will be 1) Weighted daily as indicated. Patient was able to show
kog gakakaon pero ganiwang
gihapon” as verbalized by the
nutrition: able to:
Ingest appropriate
R: Assess adequacy of nutritional
intake.
appropriate amounts of ingested
calories as indicated in his
patient.
Objective Cues:
less than
amounts of calories
Display
2) Ascertained client’s dietary
program and usual pattern;
diabetic diet.
He has also shown signs of
Type 2 Diabetes Mellitus body usual/increased compare with recent intake. maintained usual energy level as
Polyuria - 1600 mL/8 energy level R: Identifies deficits and evidenced by resumed ADLs
hours requiremen Display normalization deviations from therapeutic such as walking around the
Polydipsia - more than of blood glucose needs. room for exercise, clothing, and
2.5 liters per day ts related levels from 236 3) Adviced to eat foods low in eating.
Polyphagia
Poor muscle strength - to insulin mg/dL to 120 mg/dL
or lower.
sugar and
carbohydrates.
low in He has also verbalized
adherence to the treatment
3/5
HGT - 236 mg/dL; Taken
deficiency Verbalize adherence
to medication
R: To lessen increased blood
glucose level.
regimen by stating that he needs
to constantly monitor his
on November 19, 2010 regimen. 4) Encouraged compliance to glucose level and take his
Weight: 67 kgs. (upon Long term goal: treatment regimen. medications as prescribed.
admission) Maintain normal R: For faster recovery and prevent However, his blood glucose level
Weight: 65 kgs glucose levels from further complications. has only decreased to 186
(November 20, 2010) 80-120 mg/dL. Dependent: mg/dL after 4 hours of care.
Weight loss = 2 kgs. 5) Performed fingerstick glucose Long term goal:
testing. However, the group has not
R: To monitor blood glucose levels evaluated the long term goal for
and check for hyperglycemia or the patient as we had only taken
hypoglycemia. care of the patient for 2 days.
6) Administered Humulin R, 10
units, subcutaneous, STAT as
prescribed.
R: To correct high glucose level.
7) Administered Galvus 50 mg, 1
tab, OD as prescribed.
R: To correct high glucose level.
8) Administed Januvia 25 mg, 1
tab, OD as prescribed.
R: To correct high glucose level.
Drugs
Chronic obstructive
pulmonary disease
Thank